The "Childmyths" blog is a spin-off of Jean Mercer's book "Thinking Critically About Child Development: Examining Myths & Misunderstandings"(Sage, 2015; third edition). The blog focuses on parsing mistaken beliefs that can influence people's decisions about childrearing-- for example, beliefs about day care, about punishment, about child psychotherapies, and about adoption.
See also http://thestudyofnonsense.blogspot.com

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Saturday, February 27, 2016

It would be
silly to claim that no parent ever caused a child to be alienated from and to
reject contact with the other parent. This can be done inadvertently, as when
one parent is afraid of the other and an infant sees this through social
referencing, or it can be done intentionally with the goal of hurting the other
adult. However, it is not silly to consider that the apparent alienation of a
child, with refusal to be with one parent, can have a wide variety of causes.
That range of causes is not so easy to explore, and a parent who feels rejected
may readily assume that any problem is of the other parent’s making.

Benjamin Garber has discussed one possible
situation, in which each parent believes that the child fears and wants to
avoid the other parent. He calls this pattern the “chameleon child” (Garber,
B.D. [2014]. The chameleon child: Children as actors in the high conflict
divorce drama. Journal of Child Custody,
11,25-40). The point of Garber’s discussion is not to blame children, but
to consider that they are not simply passive recipients of parental pressure.
Rather, they actively involve themselves in an uncomfortable situation and
attempt to adapt themselves to the situation, and the situation to themselves. In
pointing this out, Garber follows (without mentioning it) some important
principles of modern developmental psychology. One of these principles is that
the effects of family experiences are not just bidirectional but transactional:
parents and children affect each other, and the ways in which they do this
change over time. The second is that children’s own characteristics can
influence the ways in which experiences affect them. This is most often
discussed in terms of the ways a child’s genetic make-up and her experiences
interact to change developmental outcomes, but it can also be considered with
respect to the ways a child’s needs may evoke responses from caregivers, or the
ways a child may actively seek to get from caregivers what he or she wants; in
either of these cases, the child can also be influenced by the caregivers’
responses.

The “chameleon child”, according to Garber, is one
who tells the father how much the child likes to visit him, and what bad things
the mother does. The same child does the reverse with the mother, praising her
and criticizing the father. For both parents, the child cries and resists going
to the one she is not presently with. Each parent is convinced that the other
parent is mistreating the child and that the child hates and rejects the other
one.

What is going on here? Is the child simply a wicked
little creature who lies and likes to cause trouble? No-- a much simpler and more accurate statement
would be that the child wants both parents and wants to have them together. The
child wants both parents to love him, so he tells each one what that parent
seems to be fascinated by hearing: 1. How much the child likes to be with the
present parent, and 2. What bad things the other parent does. This line of
conversation gets the deep interest and attention of whichever parent is
hearing it at a given time. The child does not imagine that parental conflict
is heightened by the stories told to each parent. On the contrary, he may
imagine that the conflict is just about him, that one or both parents don’t like
him so much and that’s why each is with him for only part of the time, and that
if he can get them to like him more, they will reunite and both be with him all
the time.

What about the parents? Are they trying to cook up
some attack against each other? They may be, but chances are that they, and
their attorneys, and their therapists, are all just suffering from the same
confirmation bias that all of us have to fight. This means that they (and we)
are ready to hear and remember information that supports a way of thinking that
we already have, and ready to ignore or forget anything that confuses us by contradicting
or only partially supporting our existing assumptions. For each one, the
co-parent is a person who is unreliable, or unsympathetic, or sneaky, or cruel
in some way-- if it were not so, they
would not have separated, and that is the opinion of both the “one who left”
and the “one who was left”. That such a person might mistreat a child in some
way seems fairly credible, and anything that supports the idea that
mistreatment has actually happened fits beautifully into confirmation of this assumption. In addition, of course, each of
the parents sees himself or herself as a protector of children, and to find
that someone else treats the child badly and should be stopped is an event that
confirms the bias about the self as well as about the other adult. These biases
are so powerful that most parents do not investigate further or seek other
information to help them decide whether a conclusion is correct—and this may be
true of the attorneys and the therapists as well.

Garber recounts an anecdote that shows how confirmation
bias can not only lead to the wrong conclusion, but can interfere with seeking stronger
evidence about an issue. A four-year-old girl returned from a visit to her
father and announced cheerfully to her mother, “Daddy showed me all about sex!”.
The mother was flabbergasted, but not altogether surprised-- after all, we all know about pedophiles, don’t
we? After a restraining order and much consulting and investigation, it turned
out that the father had taken the girl to a museum with an entomology exhibit.
He showed her all about, not sex, but insects. The child was obviously safe and
happy, but the mother’s confirmation bias prevented her from asking a few
questions about this “sex” business, which might have revealed that butterflies
and moths were the real topic.

That child’s “chameleon” position came to be when
the mother misunderstood or misinterpreted a statement that everyone would
agree to be ambiguous at the very least. But a number of children provide
fodder for their separated parents’ confirmation biases by adapting their
behavior to what a parent seems to want to hear, praising the present parent
and criticizing the absent one. Like real chameleons, the children make
themselves safe and comfortable by doing what the social environment signals
them to do, in ways that are no more antisocial than telling Aunt Lily you like
your birthday present when you actually don’t. We want children to have these
skills of social adaptation. We also want to know if anything bad does happen
to them. For the best outcome, then, we need for co-parents, attorneys, and
therapists to examine their own confirmation biases and seek all the factors
that may determine a child’s attitudes and statements, rather than leaping to
either the parental alienation or the child
abuse conclusions.

Friday, February 26, 2016

Both professional journals and little independent
blogs like this one have been stating for years that Reactive Attachment
Disorder may be accompanied by aggressive behavior, but it is not the cause of
that behavior, nor is aggressive behavior a symptom of the disorder. The last
word about this was thought to have been said by the joint task force on
Reactive Attachment Disorder of the American Psychological Association,
Division 37, and the American Professional Society on Abuse of Children, headed
by the late, much-respected, Mark Chaffin (Chaffin et al, 2006).

Nevertheless, both parents and mental health
professionals continue to assume that “the list” promulgated by attachment
therapists, including not only aggression, but “fascination with blood and
gore”, cruelty, and unwillingness to make eye contact on the parents’ terms, is
an accurate description of Reactive Attachment Disorder. This is even evident
in master’s and doctoral theses, which are presumably approved by a committee
whose members are regarded (by someone) as knowledgeable.

Why? Why doesn’t this trailing edge pass over us?
There are lots of reasons why people believe foolish things, and no doubt they
all apply, but there is more to it than that. The problem I want to point to
today has to do with the failure of editors and reviewers to properly monitor
publications in professional journals, and the resulting publication of
inaccurate and misleading claims.

Let’s look at three such publications that I
stumbled across while looking for something else.

Taft, R.J.,
Ramsay, C.M., & Schlein, C. (2015). Home and school experiences of
caring for children with Reactive Attachment Disorder. Journal of Ethnographic &
Qualitative Research, 9, 237-246. [these authors appear to work in
special education and curriculum]

Taft et al state that “Children with RAD demonstrate
significant and often dangerous behaviors..” (p.238). They follow this
statement with a reference to the DSM-IV diagnosis, but without noting that
none of the DSM editions refers to dangerous behavior. In a later paragraph,
they reference an attachment therapy practitioner as saying (incorrectly) that
children with RAD defy traditional treatment , and then go on to say that the
Chaffin et al (2006) APSAC-DIV 37 task force reported that “some RAD children
exhibit extreme disturbances”—whereas in fact Chaffin et al acknowledged that
extremely disturbed childhood behavior is possible, but did not connect it with
RAD. Later, Taft et al describe the children as “very intentional” about
threatening or inappropriate behaviors, and state that concerning behaviors are
purposeful and directed toward targets rather than the results of temper
tantrums or responses to specific triggering circumstances. These statements
were based on interviews with parents, most of whom attended a RAD support
group (where presumably they told each other these stories and perhaps competed
to be the bravest or most martyred parent). The paper’s reference section
includes Nancy Thomas, a major promulgator of inaccuracies about Reactive
Attachment Disorder, and Michael Trout, a member of APPPAH and believer in
prenatal attachment.

Shi, L.
(2015). Treatment of Reactive Attachment Disorder in young children: Importance
of understanding emotional dynamics. American
Journal of Family Therapy, 42, 1-13. [this author is a marriage and
family therapist]

Shi describes the case
of a four-year-old boy, prenatally drug-exposed, and fostered by a sequence of
five families, one of which was said to have chained him to a table. The
current foster parents at the time of writing had three bio children and two
other foster children in the house as well as this child; the foster mother ran
a day care in her house while attending community college part-time. The father
wanted to give the child up, but the mother resisted this. In spite of some
obvious environmental problems past and present, Shi diagnosed the child as
having Reactive Attachment Disorder. Shi stated that the child fit the
“classic” RAD picture as described in DSM-IV-Tr, and then immediately proceeded
to describe the child’s relevant behaviors, none of which are described in the
DSM discussion.

The behaviors in
question were, first, “a persistent fear
state. He would eat non-stop when food was on the table and would not stop
eating until he was forced to. He would steal food and hide it in his bedroom.
He would eat garbage… shampoo and charcoal.” [N.B. these statement were exactly
as I have given them here, with no evidence of a persistent fear state actually
being given—JM].

A second category of
behaviors was “dysregulation of affect. He
urinated on the carpet when he was upset. …He broke toys on purpose, left holes
in walls…ruined furniture, abused family pets, bounced on his two-year-old
sister… He would not show emotions when hurt or injured but would cry
dramatically over small, insignificant things.” The connection between
urinating on the carpet and dysregulation of affect was not made, but as was
the case for the fear state, neither the categories nor the specific behaviors
are discussed in DSM.

A third category was “avoidance of intimacy…any attempt at
physical contact would result in his screaming at the top of his lungs. He had
no tolerance for anything soft or comforting. He… slept on a bare mattress. He
would fake emotions from time to time yet any genuine feelings and emotions
were scarcely observed.” Shi did not comment on how it could be detected that
the child was faking an emotion, or how reluctance to lie on bedding was
equated with avoidance of intimacy.

Treatment involved play
therapy sessions, plus the prescription of ten minutes one-on-one with the
foster mother every day. (The foster father also left the home, a factor that
was not further discussed.) In an outcome described as “magical” and a
“miracle”, after 16 sessions the child got a lot better and maintained his
gains over several years, during which the foster mother worked to adopt him. Certainly
the therapist and foster mother deserve full credit for their commitment and
their work with this child, but the assumption that they were “treating RAD”
was never justified.

From the abstract onward, this paper shows serious
confusion about the nature of Reactive Attachment Disorder and about the development of attachment. The
title refers to RAD, but the abstract speaks of disordered or disorganized
attachment. In reality, disorganized attachment behavior is a category used
when assessing toddler attachment by means of the Strange Situation. Young
children with disorganized attachment behave in unusual ways when reunited with
the mother after a brief separation, freezing in place, falling to the ground,
or backing toward the mother. The mothers may look frightened of the children
and are often suffering from traumatic experiences. This kind of behavior is by
no means a positive sign or a predictor of excellent development, but neither
is it a symptom of a clear-cut pathology or of Reactive Attachment Disorder.
Disorganized attachment reveals a situation in which both mother and child are
in need of help to recover from trauma, but it need not be associated with
separations or with abusive or neglectful treatment of the child; Reactive
Attachment Disorder is by definition found after situations of neglect
(sometimes including abuse) or multiple separations associated with neglect.

Having gotten off to a bad start on this paper,
Stinehart et al then compound the problem by stating their inaccurate position
on the development of attachment. Here’s what they say: “even before birth, a
fetus begins to form an attachment to the woman carrying it. After birth, an
infant will display an almost biological need [?—JM] to attach to a primary
caregiver, typically a mother… [this relationship] is consistently strengthened
as a child is comforted when scared, fed when hungry, and in general is made to
feel safe and secure. An infant will seem to seek an unbroken gaze into the
caregiver’s eyes and may attempt to mirror the caregiver’s facial expressions…”.
The authors next repeat their problem from the abstract, by referring in one
paragraph to disorganized attachment and proceeding in the next to discuss RAD,
implying without either argument or evidence that the first is to be identified
with the second. Finally (for the present purposes), Stinehart et al list a
series of symptoms that they declare to be part of Reactive Attachment
Disorder: early feeding problems, colic, failure to thrive, food hoarding,
gorging, and pica, lack of impulse control and of empathy, tantrums,
depression, inattentiveness, antisocial actions, cruelty, etc., all as seen in
various on-line lists but not in DSM.

To comment briefly on these claims: 1. Attachment does
not begin before birth; 2. Attachment is thought to develop as a result of the enjoyable
social interactions that usually accompany the caregiving routines mentioned by
Stinehart et al. 3. Infants do not make a great deal of eye contact until at
least 4 or 5 months of age. 4. When they do make eye contact, the unbroken gaze
is only a few seconds in length, as the child looks away to other parts of the
face or to other objects, then returns to mutual gaze briefly. 5. Mirroring
caregiver facial expressions occurs within a day after birth in the right
conditions, and is probably far more important in attracting the caregiver to
the baby than in establishing the baby’s attachment. 6. Need I say again that
although disorganized attachment indicates a relationship that needs support,
it is not the same thing as Reactive Attachment Disorder? No one has
demonstrated a connection between these two behavior patterns. 7. Once again,
although children may display all the problems on the list, and need help if
they do, these problems are not symptoms of Reactive Attachment Disorder.

How did these three papers get published? One reason
is that professionals trained in fields that do not involve child mental health
have convinced themselves that it is easy to pick up a developmental psychology
background that has been missing from their studies. But, more directly and
importantly, journal editors in those
fields, who cannot be expected to know all
the material relevant to every submitted paper, err by choosing reviewers who
are also untrained in child development. Thus, there is approval of publication
of claims that contradict established information and favor pseudoscientific
views of children’s mental health. Once publication has taken place, there is
no recalling the material, even when an editor revokes a published paper; it
stays somewhere on the Internet as a “peer-reviewed” publication.
(Unfortunately, this is all too often right, as the reviewer is apparently an
equal of the author with respect to understanding the issues.)

Editors and reviewers for guilty journals need to do a better job. Allowing misinformation
to be published is harmful to children and families in ways that are difficult
to undo once they have occurred.

Thursday, February 25, 2016

It may be that most readers do not remember the 2007
trial of Sylvia Jovanna Vasquez, an adoptive mother in Santa Barbara, California,
on charges of mistreating her children. According to testimony, Vasquez had
kept three of the children (then 13, 9, and 6) in cages with buckets for
sanitation and had limited the quantity and variety of their food. A fourth
girl was treated very well-- except that
arrangements were made for her to receive injections of Lupron, a drug used to
treat precocious puberty and delay development. (Because she was already 12 years
old, whatever signs of puberty she showed were certainly not precocious. In
addition, nude photographs of her were found.) In spite of evidence of mental disturbance
(see www.independent.com/news/2007/jun/07/fighting-hand-bleeds-you/
), Vasquez had been permitted to adopt these children-- and she ran a day care center as well. It was
an altercation with a worker at the day care center, and Vasquez’ threat to
have her deported, that led the worker to report the mistreatment of the
children to authorities.

Santa Barbara judge Frank Ochoa heard Vasquez’
claims that she had simply been following the directions of a book by Nancy
Thomas that was recommended to her by a caseworker and a psychologist, and he
told her that if she would explain exactly what had happened, he would give her
the minimum sentence. But by the time the trial was done-- and especially after the cages were brought
into the parking garage under the courthouse and Judge Ochoa actually crawled
inside one—he expressed regret that he had made that commitment. Incidentally,
although Vasquez was forbidden to communicate with the children, who were in
foster care, during the trial, she did so through notes in books.

Vasquez was finally sentenced to one year in prison
plus years of probation, over the objections of the prosecutor, but in line
with the promise Judge Ochoa had made. Because she had already been
incarcerated for 6 months during the investigation and trial, she actually
served only 6 more months after the conviction. The children remained in foster
care and information about them was very properly not available to the public.

Nine years later, the children are about 22, 21, 19,
and 15 years old, respectively. Nothing appears to be known about the older
two, but there has recently been news about one of the caged girls.
Nineteen-year-old Cynthia Vasquez is working at the shelter where she was taken
by authorities when the children’s situation was first revealed (http://www.keyt.com/news/caged-child-abuse-survivor-speaks-out/38138980
). Cynthia commented that as a child she just assumed that what was done to her
was supposed to happen, that it was part of the experience of an adopted child
and would eventually be over. However bizarre it seems to us to have a child
live in a cage and eat raw eggs, it was probably no more bizarre or improbable than
anything else that had occurred in Cynthia’s life until that time-- a point we should keep in mind when we think
how abused children try to make sense of their mistreatment and why they may be
emotionally attached to their abusers.

Vasquez claimed that she needed to cage and starve
the children because they had “attachment disorders”. It is hard to know what
she was thinking, but she seems to have accepted uncritically the claims of
Nancy Thomas and others that any child who has been abused and/or separated
from the birth mother must perforce have “attachment disorders”, that these
children may appear to behave perfectly normally by means of their cunning and
skill at exploiting other people, that they must be treated in order to prevent
them from becoming dangerous, and that the treatment involves the total assertion
of adult authority. Like Thomas, Vasquez
placed this “treatment” as the top priority for the children’s care, so she did
not send them to school-- education
being, as Thomas has put it, “a privilege and not a right”, and of course this
action prevents the treatment from becoming known to nosy teachers and
unsympathetic social workers or neighbors.

I am not bringing up this case in order to intrude
further into Cynthia’s life or the lives of her brother and sisters. I simply
want to point out that, contrary to the beliefs of Thomas & Co., Cynthia
obviously understands cause and effect relationships and has a strong empathic
response to children in the shelter. These capacities she developed in spite of
her exposure to the Vasquez version of Nancy Thomas methods, not because of
them.

In all candor, of course, I would like very much to
know what has become of all of the children (if I recall correctly, the boy had
been sent to a Utah boarding school), how they are doing now, and not least,
what has Vasquez been doing during her period of probation? If she has managed
to get involved with children, that is something that should be made public.

Saturday, February 20, 2016

Some divorced couples find that children easily go
back and forth from one household to the other, take it for granted that this
will happen, and maintain good relationships with both parents. But many
discover that this ideal situation is present at some times but not at others,
perhaps changing with the child’s age or other events in their lives. In some
cases, a child vehemently refuses to visit one of the parents at some point,
feelings are badly hurt, and blame is cast in various directions.

When a child “rejects” a parent, it’s all too easy
for the “rejected” or “non-preferred” person to accept advice about parental
alienation (PA) and to seek treatment that will make the child enthusiastic and
affectionate. Psychologists and others who think in terms of PA often claim
that there are only two reasons why a child would reject a parent and refuse to
visit. One is that the parent has been in some way abusive, so that the child’s
response is a rational one. The alternative is that the child is behaving
irrationally because of the influence of the preferred parent, who is
deliberately and intentionally alienating the child’s affections by stating
that that the other parent is someone to be feared and avoided.

I have no doubt that intentional parental alienation
does happen sometimes, and that this can occur even when a marriage is still
intact. It’s also possible that a parent of a young child may unintentionally
convey fearfulness of the other parent, and the child may pick up on and share that feeling, becoming reluctant to approach
one of the parents. Nevertheless, it is simplistic to assume that there are
only two categories of situations where a child rejects or avoids a parent—the
rational avoidance of a person who has been abusive, and the irrational
avoidance of a good parent at the instruction of the other parent. I would
submit that in many cases, refusal of contact may be perfectly rational in the
context of the child’s own experience and age-related needs and abilities,
although it appears irrational to the adult who considers the child’s actions
only in terms of the adult’s own needs, knowledge, and cognitive abilities—that
is, the adult approaches the issue with an adultomorphic
bias that attributes adult characteristics to the child.

Let’s look at some examples of situations where a
child has never been abused by a parent, but has excellent reasons to avoid
visiting that parent-- reasons that he
or she either will not or cannot confide to adults.

A
6-year-old boy who spends most of his time with his father begins to
refuse visits to the mother after he overhears the mother’s boyfriend
telling her she must “make a man of him” by taking away his nightlight and
spanking him if he cries. The mother does not comply, but the boy is still
disturbed and unable to explain the problem to anyone.

A
12-year-old girl who recently had her first menstrual period no longer
wants to visit her father. She can’t explain this, but she does not know
how she can handle menstrual hygiene without speaking to her father about
it, which seems to her the most embarrassing thing that could possibly
happen. What, for instance, if she got her period unexpectedly and got
blood on the bedsheets? She feels
that would be the end of the world.

A
13-year-old boy has spent occasional weekends with his mother for years,
but now does not want to go. He feels frequent intense urges to masturbate
but has no privacy in her apartment, as he has always slept in one of the
twin beds in her room. If he spends much time in the bathroom she knocks
and asks if he is feeling all right.

A
14-year-old girl has been visiting her father happily over a period of
several years, but began to refuse after the father’s girlfriend moved in
with him. A therapist consulted by the father has stated that she has
Separation Anxiety Disorder, although she has no problem going to school
or elsewhere and will visit the father’s house but does not want to sleep
over.

A boy in
his middle teens has been visiting his father overnight for ten years,
through a remarriage, a new divorce, and another marriage. He comes home
looking distressed one day and tells his mother he does not want to sleep
there again. There is no separate bed for him at his father’s house and he
is expected to share a big bed with the younger stepbrother. He does not
want to discuss this with his father and asks his mother simply to tell
the father that he would prefer to have a visit with the father somewhere
away from the house.

All these situations, except possibly the
bed-sharing, may appear “irrational” to adults who cannot or at least do not
take the child’s perspective. The child’s reluctance or inability to explain
the trouble adds to this appearance of irrationality. Although the “rejected”
parents may hasten to blame the refusal on an alienating co-parent, it’s clear
that there are several other causes for the children’s feelings. One is the
tendency, sometimes called “funneling”, for non-custodial parents to fail to
notice developmental changes and to continue to treat children as if they are
still at the age where they were when the marriage came apart. One is the
presence of new romantic partners in the parents’ lives and the difficulty of providing
the children with their accustomed time alone with a parent, complicated by the
real uncertainty about what the relationship between child and new partner
should be. Another, and an important one, is the role of verbal or nonverbal
communication about sexuality with an opposite-sex parent, whether this has to
do with the child’s own sexuality (including menstruation) or with the child’s
awareness of the parent’s love life—so especially disturbing for adolescents,
who do not want to know about this even when their parents are happily married.
All of these issues need to be considered before there are PA accusations, and
certainly before children are separated from the preferred parent’s home by
court order.

To speak of someone as “insecure” is one of the
great vague negative comments of the 21st century. Insecurity is
thought to be the cause of all kinds of problem moods and behaviors like
jealousy, backbiting, and oversensitivity to criticism. When children seem
insecure, Americans are often disturbed by the idea that they won’t grow to be
independent and self-sufficient, as our national values have long stressed.
Such children are supposed to be forced to become “not insecure”-- the classic example is this dialogue: “He’s
always carrying that blanket around. He must be insecure.” “Yeah, we’d better
take the blanket away from him.”

All this concern about insecurity is amplified when
the reference is to insecure attachment. Attachment
is important, and (as above) insecurity is important, so insecure attachment
must be extra important. Judges making child custody decisions may ask
questions about it even if expert witness psychologists have not mentioned the
issue.

But, when you come down to it, insecure attachment
is well within the normal range of development. It may be not be ideal, but
it’s okay. Insecurely attached kids grow up, go to school, have friends, get
jobs, get married, etc. Any problems they have may be related to temperament,
learning difficulties, socioeconomic status, or the continuing effect of
whatever it was about their families that made them insecurely attached to
begin with, just as much as it is
related to the insecure attachment specifically.

When Mary Ainsworth, John Bowlby’s colleague, did
her original work with toddlers tested on the Strange Situation, she assigned 65%
of them to Group B (later called securely attached), 20% to Group A
(insecure-avoidant), and about 15% to Group C (insecure-ambivalent). The Group
A children responded to brief separation and then reunion with their mothers by
avoiding or snubbing the returning mothers; Group B actively sought contact
with the returning mothers and were easily comforted; Group C were anxious
while the mother was gone, and when she came back they went to her but pushed
her away or resisted her. (Ainsworth did not use the disorganized/disoriented
attachment category, which was created later).

What if Ainsworth had never used the terms insecure-avoidant,
insecure-ambivalent, or secure? Would we be so worried about a child placed in
Group A or C by a trained observer if we didn’t use the word security to
describe what’s going on? I would speculate that we might not have so much
concern if we didn’t already associate insecurity with undesirable mood and
characteristics, especially the American bug-a-boo, lack of independence.

Ainsworth did not create her classification plan by
following the children, seeing what characteristics they later developed, and
retrospectively labeling the toddler behaviors in terms that depended on
demonstrated childhood or adult characteristics. No—she started her work with Bowlby with an existing
assumption about security as a foundation for personality. While a graduate student in Toronto in the
1940s, Ainsworth worked with William Blatz, who did not publish much but who
had formulated a theory of personality that stressed early development and the
basic need for exploration and learning. (For interested readers, I should
point out that I am using only a small amount of the information about Blatz
provided by van Rosenmal, van der Horst,
and van der Veer in their 2016 paper “From secure dependency to attachment”,
History of Psychology, Vol. 19, pp.22-39). Blatz defined security as “the state
of consciousness that accompanies a willingness to accept the consequences of
one’s own decisions and actions”, or occurred if someone else could be depended
on to help with the consequences. Young children experience an immature,
dependent security, but when they are
sure an adult will help them, they can explore and use the adult as a secure
base. Confidence and movement toward independence come with exploration and
learning about the world. Initially, Blatz felt, a stable mother/caregiver was
essential, but as the child explores further, a whole social network comes into
the picture. People who do not have a stable caregiver or who do not learn
successfully from exploration have to depend on defense mechanisms like rationalization
to deal with the discomfort of insecurity.

In the first work that Ainsworth and Bowlby did
together, they referred to the positive relationship between mother and child
as one of “secure dependency”. Not much later, however, they substituted the term
“attachment” for “secure dependency”—“attachment”
having been used for a long time to mean something like “devotion” in adult
relationships. Thus, “attachment” and “security” developed the connection that
is now so well known, leading many people to assume that an insecure attachment
is no attachment at all.

Am I suggesting that early attachment has no
significance at all? No, of course not. Early attachment behavior is a
reasonably good proxy measure for how caregivers act toward the child, and how
caregivers act toward the child will help shape development throughout
childhood and adolescence. Certainly, the small proportion of children who show
disorganized attachment by freezing or falling to the floor when reunited with
the primary caregiver are showing us that there are problems in the relationship
(often associated with traumatic experiences the caregiver has had). These
parents and children need help to improve their situations.

However, most ways of caring for children are “good
enough”, whether or not they are associated with insecure attachment behavior.
Their outcomes are adequate for development of adults who can take normal
places in society. Insecure attachment is not the cause of horrible outcomes,
for the individual or for the rest of us. In any case, children who appear
insecurely attached may well move toward secure attachment over time. Decisions
about child custody or placement should not depend on whether attachment is
assessed as secure or insecure in the toddler period. That may appear to be a
scientific use of data about child development, but instead it is just one more
effort to detour around the complexities of family issues and to define that
difficult concept, the best interest of the child.

Thursday, February 18, 2016

Hello readers-- I am starting a new post for responses to http://childmyths.blogspot.com/2011/07/eye-contact-with-babies-what-when-why.html.

There is a long list of queries and responses on that post, and I cannot seem either to publish or to answer any more. I hope people will see my notice and come over to this one instead.

I am going to start with a query I received but could not publish on the old post.

AND-- I'm so sorry but I cannot make this query and response line up properly with the margins! It looks okay to me, but when I publish it's out of line. I hope people can figure out what this reader and I were talking about. When I have time I will retype the whole thing, which may be the only solution... no, wait! Problem solved-- I managed to post this as a comment.

Hi Dr. Mercer,

First off, I find it so kind the amount of time you've taken to answer so many questions

from concerned parents.

I'm hoping you have time for one more as I've been worried sick about my son.

I'm a FTM of a 12 week old boy (born 3 weeks early). Since birth,
he has never made eye contact with anyone. He looks all around but never at faces. I've tried endlessly to get him to track toys and he won't do that either. I think I've been able to get him to track a page out of a book but I say think b/c I'm not sure he actually tracked it or I just happened to be holding it where his eyes landed. He's also fussy and doesn't like to be cuddled. Only will let you carry him over the shoulder. He does cooh but not often.

As mentioned, I am absolutely terrified that he has autism. The lack of eye
contact is so disheartening. Any advice would be appreciate.

Dear Anon-- I am not sure whether you mean that he is now 12 weeks
corrected age, or whether his age dating from when he should have been born is only 9 weeks. If it's the latter, I'm not at all surprised that he has not been making eye contact as you want,and I would be quite surprised if he had done so at birth! He will probably startvocalizing more, soon.

A lot of babies like to be carried on the shoulder. Some even much prefer
to be held facing outward, with the back toward the caregiver. These are just individual differences and not associated with any developmental problems. It sounds as ifyou've been willing to let him "teach" you how he likes to be held, and that's great.

As for tracking things visually,you may notice that when your pediatrician does this kind of testing, he or she uses a small pencil flashlight which is easy to see against any background and in any light. You could try that if you want to, but please understand that if you can't get him to do it, you should mention it to the pediatrician, but it has nothing to do with autism.

Like all mothers nowadays, you are frightened of autism, but let me tell you a few things. First, babies have a normal period of "autism" (focus internally rather than externally) in the first few months. It can typically be quite hard to get their attention during this time, or even to comfort them when they're upset. Second, babies cannot be diagnosed as autistic at this age, and even when they are diagnosed after the first birthday, many of them show typical development after that. All those "red flags" you've been reading about have to be considered in the context of developmental age.Third, even when toddlers or preschoolers are diagnosed as autistic, this is not the end of their development, and many have only mild cases.

I hope you will try to get all these things into perspective. If you cannot manage this,it may be that you are feeling unusually anxious or depressed at this point in your life and need some help with those feelings. Your OB/GYN may be able to help decidewhat you need and refer you for treatment if appropriate. Post-partum emotionalconcerns happen to a whole lot of people and are nothing to be embarrassed about.There's help out there if you need it!

Wednesday, February 17, 2016

What is a syndrome of behavior and/or causes that
leads to a mental health diagnosis? When we talk about mental health diagnoses,
we are trying to use an analogy to diagnoses of physical illnesses and
injuries. Like mental health diagnoses, classifications of physical health
problems have to place people into categories for which they meet some, but not
necessarily all, of the criteria. These diagnoses may in both cases also involve
symptoms that can be found among the criteria for more than one category of problems.
But-- there is one big difference
between mental health and physical health diagnoses. For problems of physical
health, there is a physical cause that may be hard to ascertain but is
certainly there; without a specific physical cause, a specific diagnosis will
not be made.

In the case of mental health diagnoses, physical
causes are rarely present in detectable forms. Genetic factors may play
important roles in causing mental illness, but although there is much ongoing
research in this area, the complexity of the human genome makes it difficult to
isolate genes and genetic events that may be at work. Occasionally criteria for
mental health diagnoses include causes in the form of experiences (for
example, post-traumatic stress disorders), but such causes have not been demonstrated
for most mental health disorders, and it may be very difficult to trace
histories of experience in early life.

Our lack of understanding of causes of mental illness
means that criteria for a diagnosis generally depend on systematic observation
of many cases and the establishment of evidence that certain symptoms tend to
be found together in ways that may overlap somewhat with other diagnostic
categories but that can be regarded as having their own unique pattern. Our
understanding of these patterns changes with new information, and that is why
lists of diagnostic categories and their criteria change over time, and
categories may be added or deleted.

In the 2013 edition of the American Psychiatric
Association’s Diagnostic and statistical
manual of mental disorders (DSM-5), changes were made in the description
and criteria for Reactive Attachment Disorder, a diagnostic category that had
been changing over the years since 1980, when it was classed as a disorder of
feeding. This category had involved two potentially problematic patterns of
social interaction by young children, one in which the child was anxious about
separation and clung to caregivers, and one in which the child appeared interested
in adults but indifferent to particular people, with no preference for familiar
caregivers. In DSM-5, two separate categories were used. In one, Reactive
Attachment Disorder, the child does not seek comfort from caregivers or respond
to it when distressed; the child is not responsive to others and shows little
positive emotion; the child may be irritable, sad, or fearful when interacting
with an adult, even when there seems to be no evident threat to the child. For
this diagnosis, there must also be a history of extremes of inadequate care,
the child must be at least 9 months old because attachment does develop
sufficiently before that age, and the child must be less than five years old
when the problematic behavior begins.

The second DSM-5 category, Disinhibited Social
Engagement Disorder, involves behavior rather different from the typical responses
of young children to separation from familiar people or to the approach of
strangers. Children with DSED readily approach strangers and are overly
familiar with them in physical and verbal ways (as compared to what is typical
of young children). They are less likely than typical children to “check back”
by looking at or speaking to a familiar caregiver when exploring unfamiliar
settings. They show little hesitation about going with an unfamiliar adult. To
receive the DSED diagnosis, the child must also have experienced extremes of
inadequate care and be at least 9 months old. There is no upper limit for when
the behavior begins, no doubt for the
reason that such friendly, non-anxious behavior is much more typical of older
children and should not be seen as problematic; what is “overly familiar” also
changes with age.

DSM-5 is often treated as the “last word’ about
mental health diagnoses, but in fact there are other sets of diagnostic
categories. One of these is the one your insurance carrier is likely to use:
the World Health Organization’s International
classification of diseases and related healthproblems (ICD-10). ICD-10 includes the diagnostic category Reactive
Attachment Disorder of Childhood and describes this as involving persistent
abnormalities in the child’s pattern of social relationships, including
fearfulness and hypervigilance, poor social interaction with peers, aggression
toward self and others, misery, and possible growth reduction or growth
failure. This syndrome is said probably to occur as a result of serious neglect,
abuse, or mishandling, but unlike DSM-5, such a history is not required for the
diagnosis. It’s notable that although the term “attachment” is found in the
name of the diagnosis, the criteria do not particularly mention social
interactions with adult caregivers.

ICD-10 also includes Disinhibited Attachment Disorder
of Childhood, which is essential described in the same way as DSM-5 described
DSED. The interesting difference is that ICD-10 says that depending on circumstances there may be associated emotional or
behavioral disturbance.

ICD-10 dates back to an initial publication in 1992,
and there is an ICD-11 in the works. Drafts of proposed material for ICD-11 are
available. For Reactive Attachment Disorder, the draft proposes that the
disorder occurs in cases of grossly negligent child care and involves grossly
abnormal attachment behaviors. The child does not seek comfort from familiar
caregivers or other adults and does not respond to offered comfort. The
disorder cannot be diagnosed before one year of age or 9 months developmental
age. The draft notes that there are normal variations in selective attachment behavior
and these should not be confused with Disinhibited Attachment Disorder.

The ICD-11 draft uses the term Disinhibited Social Engagement Disorder instead of Disinhibited
Attachment Disorder, and again proposes that this problem must occur in the
context of a history of inadequate care. The criteria are similar to the DSED
criteria. The disorder is not to be diagnosed before age one year and must
begin before age 5 years.

But ICD-10 and ICD-11 are not the “last words”
either. Because diagnosis of early childhood mental health problems may be
quite a different task than diagnosis of adults, the Diagnostic Classification of Mental Health and Development Disorders of
Infancy and Early Childhood (Revised edition; DC:0-3R) has been developed.
DC:0-3R has dropped the term Reactive Attachment Disorder and instead refers to
Deprivation or Maltreatment Disorder of Infancy. This may appear in three
patterns. The first, an emotionally withdrawn or inhibited pattern, may be
characterized by failing to seek comfort when stressed, showing few attachment
behaviors (cooperating, seeking help from others), appearing emotionally
blunted, showing frozen watchfulness, avoiding and failing to initiate social interactions,
or actively resisting comforting. The second pattern, an indiscriminate or disinhibited pattern,
involves a lack of the usual shyness about interacting with strangers, seeking
comfort and proximity even with strangers, and even resisting comforting by
familiar people. In a third pattern, there may be a combination of features
from the first two. As its title suggest, DC:0-3R is a classification system
for infants, toddlers, and preschoolers, and would not be used for older
children.

What’s the fifth way of looking at ‘attachment
disorders”? I’m only mentioning this one because I want readers to compare it
to the legitimate attempts to define the diagnosis. Here’s part of a list of
symptoms given by Nancy Thomas, the well-known proponent of an alternative theory of child development, at www.attachment.org/reactive-attachment-disorder/
: superficially engaging and charming, lack of eye contact on parents’ terms, indiscriminately
affectionate with strangers, cruel to animals, etc. etc. If anyone reading this
has been exposed to this view of “attachment disorders”, let me suggest that
you compare it carefully to the DSM-5, ICD-10/11, and DC:0-3R efforts. Keep in
mind that that the first four were based on careful observation and ongoing
discussion by people trained in research methodology. The last one was borrowed
from the old Hare Psychopathy Checklist, slightly revised to bring in some
alternative beliefs about eye contact and some behaviors related to conduct
disorders—also, to give parents a good scare.

It’s evident that professionals are still refining
their formulations of “attachment disorders”. However, none of these efforts so
far have included the list at www.attachment.org,
and I am quite certain that they never will.

Sunday, February 7, 2016

Terri and Svetlana-- I am having difficulty publishing your comments and my replies. I'll work on this, but maybe there are just too many comments on that post? You might want to try sending comments to this post.

Pignotti, M., & Mercer, J. (2007). Holding Therapy and Dyadic
Developmental Psychotherapy are not
supported, acceptable social work interventions: A systematic research synthesis revisited. Research on Social Work Practice,17 (4),
513-519.

“Attachment Therapy: Science adversaries appeal to
scientific evidence.” Institute of Contemporary
British History conference, “Science, Its Advocates and Adversaries”, London, July 7-9, 2003.

“Analyzing Attachment Therapy”, at “Right From the Start:
Supporting the Earliest Relationships
and their Impact on Later Years,” professional conference presented by Youth Consultation Services Institute for Infant and Preschool Mental
Health, Newark, Sept. 24-25, 2003
(continuing professional education credit-bearing).

“Attachment and Attachment Therapy: The Good, the Bad, and
the Ugly”, at annual meeting, Gateway Maternal-Child Health Consortium. East Orange, NJ, March 25,
2004 (Continuing professional
education credit).

“Attachment.” Annual conference of New Jersey Association
for Education of Young Children, East
Brunswick, NJ, Oct. 16, 2004 (continuing professional education

“Don’t Be So [Un]critical!
Using Critical Thinking to Foster Mastery of Child development Concepts.” Developmental Science Teaching Institute,
Society for Research in Child Development, April 1, 2009, Denver, CO.

“Are There Research-Based
Child Custody Evaluations?”. Conference on Infants and Children in the Courts,
sponsored by Youth Consultation Service and NJAIMH; Clara Maass Medical Center,
Belleville, NJ, March 19, 2010.

“Jirina Prekopova’s
holding therapy: Scientifically founded or otherwise?” Conference of the
International Working Group on Abuse in Child Psychotherapy, April 20, 2013,
London.

“ ‘Nancy Thomas parenting’ in the U.S. and
Russia: Another part of the holding therapy problem.” With Yulia Massino. Conference of the
International Working Group on Abuse in Child Psychotherapy, April 20, 2013,
London.

About Me https://en.wikipedia.org/wiki/Jean_Mercer

Jean Mercer has a Ph.D in Psychology from Brandeis University, earned when that institution was 20 years old (you do the math). She is Professor Emerita of Psychology at Richard Stockton College, where for many years she taught developmental psychology, research methods, perception, and history of psychology. Since about 2000 her focus has been on potentially dangerous child psychotherapies, and she has published several related books and a number of articles in professional journals.
Her CV can be seen at http://childmyths.blogspot.com/2009/12/curriculum-vitae-jean.mercer-richard.html.